Deutsche Gesellschaft für Interntationale Zusammenarbeit (GIZ), Phnom Penh, Cambodia.
Health Econ. 2013 Dec;22(12):1440-51. doi: 10.1002/hec.2895. Epub 2012 Dec 26.
There has been recent controversy about whether aid directed specifically to health has caused recipient governments to reallocate their own funds to non-health areas. At the same time, general budget support (GBS) has been increasing. GBS allows governments to set their own priorities, but little is known about how these additional resources are subsequently used. This paper uses cross-country panel data to assess the impact of GBS programmes on health spending in low-income and middle-income countries, using dynamic panel techniques to estimate unbiased coefficients in the presence of serial correlation. We found no clear evidence that GBS had any impact, positive or negative, on government health spending derived from domestic sources. GBS also had no observed impact on total government health spending from all sources (external as well as domestic). In contrast, health-specific aid was associated with a decline in health expenditures from domestic sources, but there was not a full substitution effect. That is, despite this observed fungibility, health-specific aid still increases total government health spending from all sources. Finally, increases in total government expenditure led to substantial increases in domestic government health expenditures.
最近出现了一些争议，即专门用于卫生保健的援助是否导致受援国政府将自有资金重新分配到非卫生保健领域。与此同时，一般性预算支持（GBS）的数额一直在增加。GBS 允许各国政府设定自己的优先事项，但对于这些额外资源随后的使用情况，人们知之甚少。本文利用跨国面板数据，采用动态面板技术，在存在序列相关的情况下估计无偏系数，评估了 GBS 方案对低收入和中等收入国家卫生支出的影响。我们没有发现明确的证据表明 GBS 对源自国内的政府卫生支出产生了任何积极或消极的影响。GBS 对来自所有来源（包括外部和国内）的政府卫生总支出也没有观察到影响。相比之下，针对具体卫生问题的援助与源自国内的卫生支出减少有关，但没有完全的替代效应。也就是说，尽管存在这种可替代性，针对具体卫生问题的援助仍会增加来自所有来源的政府卫生总支出。最后，政府总支出的增加导致国内政府卫生支出的大幅增加。
